title: Is it worthwhile to conduct a randomized controlled trial of glaucoma screening in the United Kingdom?
abstract: OBJECTIVE
  To assess the value of conducting a glaucoma screening randomized controlled trial in the UK.
  
  
  METHODS
  Decision model based economic evaluation and value of information analysis. Model derived from a previous health technology assessment. Model updated in terms of structure and parameter estimates with data from surveys, interviews with members of the public and health care providers and routine sources.
  
  
  RESULTS
  On average, across a range of ages of initiating screening (40-60 years), glaucoma prevalence (1-5%), screening uptake (30-100%), and the performance of current case finding, screening was not cost-effective at a £30,000 threshold per quality adjusted life year (QALY) from the perspective of the National Health Service (NHS). The societal value of removing all uncertainty around glaucoma screening is £107 million at a threshold of £20,000 per QALY. For informing policy decisions on glaucoma screening, reducing uncertainty surrounding the NHS and personal social care cost of sight impairment (£74 million) was of most value, followed by reducing uncertainty in test performance (£14 million) and uptake of either screening or current eye care (£8 million each).
  
  
  CONCLUSIONS
  A glaucoma screening trial in the UK is unlikely to be the best use of research resources. Further research to quantify the costs of sight impairment falling on the NHS and personal social services is a priority. Further development of glaucoma tests and research into strategies to promote the uptake of screening or current eye care such as through the use of a behavioural intervention would be worthwhile.
authors.affiliation: Senior Clinical Research Fellow in Health Services Research, School of Medicine, University of St Andrews, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Burr
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Hernández
authors.forename: Craig
authors.initials: C
authors.lastname: Ramsay
authors.forename: Maria
authors.initials: M
authors.lastname: Prior
authors.forename: Susan
authors.initials: S
authors.lastname: Campbell
authors.forename: Augusto
authors.initials: A
authors.lastname: Azuara-Blanco
authors.forename: Marion
authors.initials: M
authors.lastname: Campbell
authors.forename: Jill
authors.initials: J
authors.lastname: Francis
authors.forename: Luke
authors.initials: L
authors.lastname: Vale
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005901:Glaucoma / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic / Q000191:economics; D006113:United Kingdom / Q000453:epidemiology
keywords: decision analysis; health policy; ophthalmology; public health